TYPE Original Research

PUBLISHED 03 March 2023

DOI 10.3389/fpubh.2023.1147789

Understanding online health

OPEN ACCESS information seeking behavior of
older adults: A social cognitive
EDITED BY
Shekhar Chauhan,
International Institute for Population Sciences
(IIPS), India
REVIEWED BY
perspective
Yibo Wu,
School of Public Health, Peking
University, China Xiumei Ma1 , Yunxing Liu2 , Pengfei Zhang3 , Rongtao Qi4 and
Zhichao Hao,
Southwest University, China Fanbo Meng4*
1
*CORRESPONDENCE Faculty of Business, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China, 2 Industrial
Fanbo Meng Design Department, Eindhoven University of Technology, Eindhoven, Netherlands, 3 School of Political
fanbomeng@jiangnan.edu.cn Science and Public Administration, Soochow University, Jiangsu, China, 4 School of Business, Jiangnan
University, Wuxi, Jiangsu, China
SPECIALTY SECTION
This article was submitted to
Aging and Public Health,
a section of the journal Introduction: Online health information seeking has been verified to play
Frontiers in Public Health
a crucial role in improving public health and has received close scholarly
RECEIVED 19 January 2023 attention. However, the seeking behavior of older adults, especially the underlying
ACCEPTED 13 February 2023
PUBLISHED 03 March 2023
mechanism through which they are motivated to seek health information online,
CITATION
remains unclear. This study addresses the issue by proposing a theoretical model
Ma X, Liu Y, Zhang P, Qi R and Meng F (2023) leveraging social cognitive theory.
Understanding online health information
seeking behavior of older adults: A social
Methods: IT self-efficacy and IT innovativeness were identified as personal factors
cognitive perspective. and professional support and social support were identified as environmental
Front. Public Health 11:1147789. factors. We conducted a survey that included 347 older people in China and
doi: 10.3389/fpubh.2023.1147789
examined the research hypotheses with a structural equation model.
COPYRIGHT
© 2023 Ma, Liu, Zhang, Qi and Meng. This is an Results: IT self-efficacy and IT innovativeness facilitate older adults to seek
open-access article distributed under the terms health information online by increasing their perceived benefit of using the
of the Creative Commons Attribution License internet. Additionally, professional support and social support enhanced older
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the adults’ online seeking behavior by promoting their health awareness. We also
original author(s) and the copyright owner(s) found that perceived benefit displayed a stronger impact than health awareness
are credited and that the original publication in on older adults’ behavior related to searching for health information online.
this journal is cited, in accordance with
accepted academic practice. No use, Conclusion: This study reveals that IT self-efficacy, IT innovativeness, professional
distribution or reproduction is permitted which support, and social support will promote older adults to seek health information
does not comply with these terms.
online by enhancing their health awareness and perceived benefit. The findings of
this study provide significant theoretical and practical implications.

KEYWORDS

online health information seeking, older adults, social cognitive theory, health awareness,
perceived benefit

1. Introduction
The rapid development of information technology has made the internet the most
popular source of health information based on convenient access and quick response, and
the number of people making use of the internet to search for health information has
continued to grow. National surveys conducted in America, German, China and other
countries indicated that a large proportion of internet users frequently searched for health
information, totaling more than 50% of the respondents in those countries (1). Especially in
the context of the COVID-19 epidemic, the internet has become the primary means as well
as the best way to obtain health information.
Health information seeking behavior has been the subject of scholarly attention since
the 1960’s. Recently, the advent of the information technology age and internet growth have
focused the spotlight on online information seeking concerning health-related topics. The
term online health information seeking refers to individuals using the internet to search for

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Ma et al.
find information about their health, risks, illnesses, and health-
protective behaviors. Ease of access, immediacy, and diversity
of information sources are all factors that have contributed to
individuals choosing online information as their preferred source
for health information (2). In fact, empirical evidence demonstrates
significant impacts of internet-based health information on
individuals’ physical and psychological health (3, 4).
In particular, scholars are paying increasing attention to older
adults’ behaviors related to seeking health information online (5–
7). According to the World Health Organization, the population of
adults over age 60 will reach 2.1 billion by 20501 As a result of the
aging of the world’s population overall, the tremendous growth of
healthcare and health information needs has become a significant
issue. Although seeking health information online is beneficial in
addressing or solving health problems, its popularization among
older adults faces many challenges due to these individuals’
generally lower cognitive and technical abilities. For example, many
older adults suffer a lack of technical skills and internet search skills
that impedes them from using the internet to access information
(8). In addition, some research has indicated that older adults tend
to rely on their cognitive ability and existing medical knowledge
when seeking health information; however, their cognitive abilities
have been shown to typically decline with age (9). Therefore,
identifying factors that can support older adults to search for
health information online has major implications in both practice
and research.
Although prior studies have made a great effort to identify
the determinants of online health information seeking behavior
(10–12), investigations into better ways to support and encourage
older adults’ search behavior remain scarce, and the underlying
mechanisms are yet unclear. For example, some researchers
identified such instrumental factors as information quality,
trustworthiness, and utility of information as the dominant
predictors of online health information seeking (1). However, in the
case of older people, obstacles to searching for information online
include a having negative attitude about the internet, entertaining
poor health beliefs, and suffering IT deficiencies and low support
from others (5). Thus, instead of concentrating on factors related to
the health information itself, studies should pay more attention to
the individual and environmental factors that directly affect older
adults, such as individual cognition, IT resources, and external
support. Furthermore, attaining deeper understanding of how to
support older adults in searching for health information online
requires exploring the mechanism through which these factors
influence their health information seeking behavior.
This study addressed the above issues by drawing upon social
cognitive theory to develop a theoretical research model. Two
reasons support the choice of this theory for the current study.
First, social cognitive theory has been widely used to explain and
predict individuals’ behavior and decision-making, especially in the
contexts of health behaviors and information behaviors (13, 14).
Second, social cognitive theory illustrates how personal factors
and environmental factors simultaneously influence individual
behavior (15), which fits well with the current study’s research
1 https://www.who.int/news-room/fact-sheets/detail/ageing-and-
health
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10.3389/fpubh.2023.1147789
objective. In this study, we conceptualized IT efficacy and IT
innovativeness as observable personal factors and conceptualized
social support and professional support as the environmental
factors of interests. Next, we examined how both types of factors
influenced the online search behavior of older adults seeking health
information through increasing their perceived benefit of using
internet and their health awareness.
This study makes several contributions to the field. For
example, the findings provide a new understanding of how older
adults seek for health information online from the perspective of
social cognitive theory. In particular, this work is one of the first
to empirically investigate how the targeted information seeking
behavior is influenced by older adults’ individual IT capacity
and environmental support. In addition, this study clarifies the
influencing mechanism through introducing the specific cognitions
of perceived benefit and health awareness. This outcome fills
the gap left by previous studies that focused primarily on
exploring influencing factors while overlooking the underlying
mechanism. Lastly, this study verifies specific personal factors
and environmental factors affecting older adults based on their
characteristics in the context of searching for health information
online. This aspect of the current study thus complements the
existing research while also providing practical suggestions on
how to improve older adults’ efforts on looking for health
information online.
2. Literature review and theoretical
background
2.1. Online health information seeking of
older adults
The development of information technology has caused the
internet to become the main source for health information
seeking (16); as a result, many studies have focused on online
health information seeking behavior. Scholars have used multiple
perspectives to investigate this topic and verified its crucial role
in healthcare. For example, Zhao and Zhang (17) found that
health-seeking on social media could fill the demand for health
information while also providing social and emotional support via
peer-to-peer interaction.
Notably, the growth in the number of older adults and
their high prevalence of health problems has attracted scholars’
close attention to older adults’ information seeking behavior.
However, even though the positive results reported for online
health information seeking, studies found that using the Internet
to obtain health information is comparatively low among older
adults (18). For example, research found that older adults have
less trust in the Internet source and present negative attitudes
toward health information from Internet (19). Moreover, older age
and reduced cognitive abilities hinder older adults’ access to the
Internet and online health information (20). In fact, a current study
illustrated that older adults relied on medical personnel, family
and friends, and health brochures rather than the Internet as main
sources of health information (7). Existing findings indicate that it
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Ma et al.
FIGURE 1
Theoretical research model.
is necessary to help older adults better utilize the Internet to search
for health information.
Recent studies have made great efforts to explore the motivators
facilitating online health information seeking behavior of older
adults. For example, Oh and Lim (21) found that communication
with medical professionals significantly accelerated use of the
Internet by older people to search for health information. Weber
et al. (7) found that older adults’ seeking behavior is related to
their lifestyle, where the Average Family Person and the Sociable
Adventurer use the internet more often for health information. In
addition, research has found that the health condition, especially
a recent diagnosis of cancer, positively facilitated older people to
seek health information on the Internet (22). An empirical study by
Zhu et al. (23) revealed that social support, and self-efficacy were
necessary predictors of health information seeking for older adults
with coronary heart disease.
However, although the current literature offers insight into
factors influencing online health information seeking of older
adults, few of the prior studies have yet clarified the influence
mechanism (24). Improving the online seeking behavior of
older people is more difficult than that of younger people
because of cognitive limitations, low electronic health literacy, and
negative attitudes toward technology (6). Thus, in addition to
exploring the influencing factors, understanding the mechanism
of influencing factors can fundamentally provide evidence for
effectively promoting the online health information seeking
behavior of older adults. According to previous findings, older
adults’ IT-related capabilities and support from their external
environment are key factors affecting their behavior to search for
health information online (25, 26). Consequently, this study aimed
to deeply revel how personal IT-related factors and environmental
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10.3389/fpubh.2023.1147789
factors might influence older adults’ behavior in terms of searching
for health information online.
2.2. Social cognitive theory
Social cognitive theory, a classical theory that finds its basis in
social learning theory, has been widely used to explain individual
actions (27). This theory can be referred to as ternary reciprocal
determinism; in other words, individual behaviors are determined
by the interaction of three factors: person, environment, and
behavior (28). In addition, these three factors can influence each
other, and any two factors can influence the third factor (28).
Since Bandura originally proposed the social cognitive theory,
it has received ongoing examination with a focus on various
individual behaviors.
The growing prominence of health issues has led to the
argument that social cognitive theory should be used to achieve
a healthy society (29, 30). In fact, social cognitive theory has
been one of the most influential theories on health behavior
(31). In particular, the key construct of social cognitive theory,
self-efficacy, has been incorporated into most health behavior
theories (32). Social cognitive theory addresses the environmental
determinants of health as well as personal determinants and
has been widely applied in the study of older adults’ health
behaviors and health management. For instance, based on the
social cognitive theory, Borhaninejad, Iranpour (33) found that
self-efficacy, social support, outcome expectations, and outcome
expectancy significantly predicted diabetes self-care behaviors
among the older people. In a similar vein, Zhang et al. (34) used
social cognitive theory to investigate the impact of information
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TABLE 1 Demographic statistics.

3.1. Personal factors
Variables Category Frequency Percentage
(%) Self-efficacy, widely recognized as a critical factor that affects
individual behavior, generally refers to the determination and
Gender Male 126 36.3
belief that individuals can complete an action under specific
Female 221 63.7 circumstances and can also refer to an individual’s assessment of
Age 55–60 40 11.5 self-ability (36, 37). The current study refers to IT self-efficacy
61–65 78 22.5
as older adults’ judgment of their ability to use information
technology to locate health-related information. Older people with
66–70 89 25.6
high IT self-efficacy are likely to experience smooth, enjoyable
70–75 100 28.8 internet interaction and will probably obtain positive outcomes
76–80 36 10.4 (38). Some previous studies have confirmed that self-efficacy can
positively affect users’ perceived value (39, 40). In the context
Over 80 4 1.2
of obtaining health information from an online source, older
Education level Middle school 41 11.8 adults who have mastered the necessary skills to use information
and below
technology tend to access valuable health information easily and
High school 185 53.5 are more likely to perceive that using the Internet to seek health
College 85 24.5 information is beneficial. Thus, our first hypothesis is based on the
Bachelor’s degree 36 10.4 assumption that IT self-efficacy will positively affect older adults’
and above perceived benefits.
Chronic disease Yes 214 61.7
H1: IT self-efficacy is positively related to perceived benefit.
As another consideration, innovativeness generally refers to
No 133 38.3
the degree to which a person prefers to use new technologies,
products, or services (41). IT innovativeness can be defined as
the willingness of an individual to try out any new information
technology (42). For the purposes of this study, IT innovativeness
communication technology usage on older adults’ loneliness; in as a personal trait represents older adults’ tendency to focus on
their findings, the authors identified the crucial role of self-efficacy and accept new information technologies or new IT functions.
and health awareness. Social cognitive theory was also successfully Prior findings suggest that individuals with higher innovativeness
applied in predicting respiratory infection prevention among older are able to cope with a higher level of uncertainty (43). Thus,
adults (35). it is reasonable to expect that a high level of IT innovativeness
Existing research suggests that social cognitive theory is suitable leads to positive experiences and outcomes from using IT. Previous
for the study of health behavior of older adults. Although many research has also noted that personal innovativeness has a strong
studies have incorporated social cognitive theory, few scholars positive effect on perceived ease of use and perceived benefit (41, 44,
have used social cognitive theory to explore older adults’ online 45). Similarly, older people who are more willing to accept and use
health information seeking. In contrast, this study focused on the new information technologies will probably perceive greater benefit
determinants of older adults’ behaviors related to searching for during the health information seeking process. These observations
health information online, giving additional attention to individual form the basis for our second hypothesis, as follows:
differences and environmental uncertainties. Consequently, this H2: IT innovativeness is positively related to perceived benefit.
paper addresses the identified research gap by proposing a research Perceived benefit refers to consumers’ confidence that they can
model based on social cognitive theory to understand how older improve their circumstances by using certain products or services
adults approach seeking for health information online. (46). In this research, perceived benefit specifically refers to older
adults’ perception of positive consequences by using information
technologies or the Internet to seek health information. Perceived
benefit is usually regarded as relative advantages, which have the
3. Research model and hypotheses capacity to meet individuals’ needs or wants and further positively
influence their behavior (47). Thus, it is reasonable to predict
development that when individuals perceive beneficial outcomes from certain
behaviors, they are more likely to continue the behavior. Several
Based on the social cognitive theory, this research took personal
factors (self-efficacy and IT innovativeness) and contextual factors previous studies have provided empirical evidence of perceived
(social support and professional support) as antecedent variables benefit significantly facilitating user behavior (48, 49). In this study,
in developing a research model to verify how personal and when older adults perceive that using the Internet to seek health
environmental factors influence older adults’ online information information can meet their needs conveniently and in a timely way,
seeking via perceived benefit and health awareness. In addition, their seeking behavior is likely to be encouraged. Accordingly, we
gender, age, education level, and the existence of chronic disease proposed the following in our third hypothesis:
were included as control variables. An illustration of the proposed H3: Perceived benefit is positively related to online health
research model appears in Figure 1. information seeking.

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TABLE 2 Reliabilities and correlations.

Cronbach’s Composite Average variance ITI ITS HA OHIS PB PS SS

alpha reliability extracted (AVE)
ITI 0.942 0.963 0.896 0.947

ITS 0.92 0.949 0.862 0.722 0.929

HA 0.902 0.939 0.837 0.284 0.221 0.915

OHIS 0.879 0.926 0.806 0.635 0.667 0.299 0.898

PB 0.893 0.934 0.825 0.714 0.652 0.236 0.611 0.908

PS 0.834 0.901 0.753 0.5 0.471 0.341 0.636 0.5 0.868

SS 0.901 0.938 0.834 0.471 0.339 0.428 0.39 0.445 0.274 0.913
Bold values refer to the square roots of AVE.

TABLE 3 Loadings and cross-loadings.

3.2. Environmental factors
HA ITI ITS OHIS PB PS SS
Social support has become an essential predictor of online
health information seeking (23, 50). Social support refers to HA1 0.883 0.25 0.23 0.288 0.241 0.37 0.352

people’s access to various resources provided by others through HA2 0.939 0.256 0.199 0.267 0.2 0.289 0.408
interpersonal communication, including support concerning
HA3 0.921 0.272 0.178 0.267 0.207 0.275 0.414
information, assistance, and comfort (51). In this study, we
specifically define social support as resources and support from ITI1 0.26 0.934 0.706 0.616 0.67 0.507 0.447

family, friends, and other non-professional social peers. Scholars ITI2 0.268 0.942 0.647 0.558 0.684 0.414 0.437
have widely verified that social support exerts a significant impact
ITI3 0.277 0.964 0.699 0.638 0.674 0.5 0.453
on individuals’ health attitudes and decisions. For example,
individuals will be more aware of making healthier lifestyle ITS1 0.198 0.653 0.94 0.58 0.595 0.398 0.321
decisions when they receive social support through interpersonal ITS2 0.186 0.65 0.932 0.635 0.593 0.467 0.277
communication (52). In addition, Choi (53) discovered that social
support, such as the care of family members, will encourage ITS3 0.231 0.706 0.913 0.644 0.627 0.448 0.345

individuals to actively participate in their own health maintenance. OHIS1 0.204 0.435 0.524 0.817 0.431 0.595 0.3
Health awareness is the consciousness to maintain one’s health;
OHIS2 0.274 0.601 0.63 0.934 0.599 0.672 0.387
thus, it is reasonable that social support is positively related to
health awareness, leading to the formulation of the study’s fourth OHIS3 0.316 0.653 0.634 0.935 0.599 0.709 0.358

hypothesis, as follows. PB1 0.261 0.611 0.482 0.445 0.846 0.4 0.449
H4: Social support is positively related to health awareness. PB2 0.216 0.649 0.637 0.598 0.932 0.47 0.368
Professional support means that individuals obtain help from
PB3 0.179 0.684 0.642 0.613 0.943 0.486 0.407
professionals who have received professional training or education
in medicine and healthcare (54). In this study, it distinguishes social PS1 0.286 0.489 0.512 0.673 0.461 0.896 0.244
support and refers to support and help from medical professionals. PS2 0.311 0.421 0.409 0.654 0.392 0.904 0.221
Since health professionals are required to master qualified and
PS3 0.288 0.392 0.306 0.487 0.451 0.798 0.249
effective health knowledge, they play a crucial role in helping
SS1 0.299 0.362 0.312 0.331 0.38 0.262 0.852
individuals establish positive health views, change health behaviors,
and attain improved health outcomes (55, 56). When individuals SS2 0.428 0.451 0.314 0.374 0.418 0.256 0.94
receive professional support from doctors, their health problems SS3 0.424 0.464 0.308 0.364 0.419 0.24 0.944
are likely to be effectively resolved. Especially in the case of older
Bold values refer to item loadings of the corresponding construct.
adults, communication with health professionals enables them to
access reliable medical knowledge and update their understanding
of health issues, which will likely enhance their health awareness. addition, some scholars have suggested that the higher the level of
Based on these ideas, we proposed the following: an individual’s health awareness, the more concerned the individual
H5: Professional support is positively related to will be about his or her health, motivating the person to further
health awareness. engage in health-promoting behaviors (62). For the purposes of this
Health awareness is generally used to measure the readiness of study, online health information seeking is regarded as a kind of
individuals to take health actions (57). People with higher health health behavior. Thus, it is reasonable to argue that people with
awareness tend to be more active and pay more attention to higher health awareness will more actively seek health information.
health information than their peers (58, 59). Previous studies have This argument supports the following proposal:
identified health awareness as a driver leading to healthy lifestyle H6: Health awareness is positively related to online health
change and able to affect health-related behaviors (60, 61). In information seeking.

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4. Methodology
4.1. Data collection
To test the research model, we collected data via a
survey that targeted to older adults who had experience using
information technology to seek health information. Because the
survey was conducted in mainland China, we employed the
backward translation method to translate the questionnaire into
the Chinese language. Before data collection began, a pilot
test was conducted to ensure that the measurement would
be clear and understandable to participants. According to the
pilot test results, along with comments and feedback from the
interviewees, we modified some descriptions and wording in the
questionnaire to make it easier to understand while maintaining the
original meaning.
Before surveying, we submitted the application to the
university and received approval from the academic board.
We then distributed the modified questionnaires to older
people in some residential communities in Northeast China.
We worked with neighborhood committees who assisted us
in recruiting participants, instructing participants to fill in
the questionnaire, and collecting the responses. Before joining
the study, all participants were informed the purpose of the
survey and voluntarily choose whether to participate. To ensure
the accuracy and validity, interviewees in the polit test were
excluded. Once they agreed to participate, participants were
given a paper questionnaire, along with a research staff who
explains precautions and assists in filling it. The survey was
anonymous, and participants were assured that the data collected
will be kept confidential and used only for academic research,
which encourages participants to answer the questionnaire as
truthfully as possible. The survey was conducted on-site, where
participants were rewarded with two eggs after completing the
questionnaire. Completed questionnaires were collected and sent
back directly to our research team for quality review and
data analysis.
Out of 500 questionnaires that were distributed, 405
questionnaires were obtained after removing incomplete responses,
rendering an 81% response rate. Since the objective of this study
concerned the older segment of the population, respondents who
were younger than 55 years old were excluded. The rationale
is that the legal retirement age for females in China is 55,
which is also widely identified as the age of older adults in
numerous studies (63–65). Additionally, the questionnaire began
with the screening question, “Have you experience in seeking
health information using information technology or on the
Internet?” If a respondent answered, “No,” the questionnaire
was considered invalid. To further improve the validity of the
questionnaires, we eliminated questionnaires that repeated
more than 75 percent of the answers. A final total of 347 valid
questionnaires was obtained for further analysis. We compared
the demographics such as age, gender, and education between
first 100 and last 100 respondents and found no significant
differences, indicating that non-response bias was not a factor
in this study. Table 1 presents the demographics information of
the respondents.
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4.2. Measurement
All measures of constructs in this study were adapted from
previous studies and were appropriately modified to fit the current
research context. Specifically, online health information seeking
(OHIS) was measured with three items adapted from Cao et al.
(66). Perceived benefit (PB) refers to older adults’ perceived benefit
of using IT to seek health information, which was measured
with three items adapted from Al-Debei et al. (47). In addition,
health awareness (HA) was measured with items adapted from
Guo et al. (67), reflecting the health concerns and consciousness
of the older adults. IT self-efficacy (ITS) and IT innovativeness
(ITI), two constructs representing the personal IT resources of
the study participants, were measured with items adapted from
Thatcher and Perrewe (68) and Zhang et al. (69), respectively. Social
support (SS) refers to the support that the participants received
from family, friends, and social networks, which was measured
with items adopted from Zimet et al. (70), while professional
support (PS) refers to support from doctors and other medical
professionals and was measured with items from Rosland et al.
(71). All measurement items are specifically listed in the Table A1.
Seven-point Likert scales were employed, ranging from 1 (strongly
disagree) to 7 (strongly agree).
5. Data analysis and results
In this study, we used structural equation modeling (SEM) with
the partial least squares (PLS) algorithm to analyze the collected
data and evaluate the research model. PLS-SEM is relatively
robust in survey data analysis while considered more suitable for
testing models with small sample sizes (72); therefore, this method
was deemed suitable for this study. SmartPLS 3.2 software was
employed as our analytic tool. Following two-step procedures, we
first examined the measurement model to ensure its reliability
and validity, then examined the structural model to confirm the
hypothesized relationships.
5.1. Measurement model
To assess the measurement model, we examined the reliability,
convergent validity, and discriminant validity of our constructs.
The reliability of constructs was assessed by checking whether
composite reliability and Cronbach’s alpha were higher than the
threshold of 0.7. As shown in Table 2, composite reliability and
Cronbach’s alpha of all constructs were >0.7, indicating good
reliability (73). Convergent validity was assessed by the item
loadings and the average variance extracted (AVE) from expected
constructs, which needed to be higher than 0.7 and 0.5, respectively
(73). Table 3 reveals that all item loadings of constructs were
>0.7; meanwhile, Table 2 shows that all AVE values were >0.5,
thereby suggesting good convergent validity. Two approaches were
employed to assess the discriminant validity. First, we compared
whether the square root of AVE for a construct was greater than
the correlation coefficients between the expected construct and
other constructs. As shown in Table 2, all constructs satisfied the
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criterion. Second, we compared whether the item loadings of a
construct were higher than the cross-loadings, which was verified
by the results presented in Table 3. These results indicated that
constructs in this study had good discriminant validities (74, 75).
To further test the potential problem of multi-collinearity for
constructs, we calculated variance inflation factor (VIF) values.
According to the results, VIF values for all constructs ranged from
1.059 to 2.052, less than the suggested criteria threshold of 3.3 (76).
Thus, multi-collinearity was not an issue in this study. In addition,
to test for common method bias, we used Harman’s single factor
test to examine whether a single component accounted for most
of the variance (77). The results indicated that the most variance
explained by one factor was 36.8%, which was lower than the
50% threshold, thus indicating that common method bias is not
a concern.
5.2. Structural model
Figure 2 depicts the structural model results. For personal
factors, both IT self-efficacy (β = 0.285, t = 4.621, p < 0.001) and
IT innovativeness (β = 0.508, t = 9.168, p < 0.001) had a positive
significant effect on perceived benefit, supporting H1 and H2. The
results demonstrate that perceived benefit (β = 0.589, t = 13.373, p
< 0.001) significantly promoted online health information seeking
behavior, supporting H3. In addition, for environmental factors,
social support (β = 0.361, t = 6.811, p < 0.001) and professional
support (β = 0.242, t = 4.284, p < 0.001) were verified to positively
impact health awareness, supporting H4 and H5, respectively.
Meanwhile, health awareness (β = 0.177, t = 3.726, p < 0.001)
showed a positive effect on online health information seeking.
Overall, the structural model explained 45.5% of the variance in
online health information seeking, along with 54.9% of the variance
in perceived benefit and 23.7% of the variance in health awareness.
Lastly, among the control variables, gender and chronic disease
revealed a positive effect on online information seeking, indicating
that female older adults and older adults with chronic disease were
more likely to seek health information online.
5.3. Post-hoc analysis
The structural model results indicated that perceived benefit
and health awareness simultaneously determined online health
information seeking; specifically, perceived benefit was influenced
by IT self-efficacy and IT innovativeness, while health awareness
was influenced by social support and professional support. To
further reveal the underlying influence mechanism, we went on to
examine whether mediating effects existed in the research model.
Employing the PROCESS, a widely used tool developed by Hayes
(78) to estimate models with mediators, we tested the mediation
effect of perceived benefit and health awareness. As presented in
Table 4, both perceived benefit and health awareness demonstrated
significant partial mediating effects. Specifically, the effects of IT
self-efficacy and IT innovativeness on online health information
seeking were partially mediated by perceived benefit. Similarly, the
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effects of social support and professional support on online health
information seeking were partially mediated by health awareness.
Furthermore, the results for the structural model visually
demonstrated that the influence path coefficient (β = 0.589)
between perceived benefit and online health information seeking
was greater than the path coefficient (β = 0.177) between
health awareness and online health information seeking. We
further statistically verified whether there were differences in
the effects of perceived benefit and health awareness on online
health information seeking. Using the approach proposed by Keil
et al. (79), we discovered that the difference in path coefficients
between perceived benefit and health awareness on online health
information seeking was significant (t = 116.384). Thus, perceived
benefit was shown to play a more important role than health
awareness in promoting older adults to seek health information
online. Similarly, we also compared the effects of IT self-efficacy
and IT innovativeness on perceived benefit, as well as the effects
of social support and professional support on health awareness.
The results in Table 5 indicate that IT innovativeness exerted a
stronger impact than IT self-efficacy, while social support exhibited
a stronger impact than professional support.
6. Discussion
6.1. Key findings
Drawing upon social cognitive theory, this study investigated
the effects of personal and environmental factors on the online
behavior of older adults seeking health information and uncovered
the influencing mechanism. The results elicit several key findings.
For example, the study findings verified that IT self-efficacy and IT
innovativeness are two crucial personal factors for older adults in
promoting their online behavior when seeking health information;
in particular, IT innovativeness was identified as having a stronger
impact. This finding is in line with practice and previous studies
that have emphasized the importance of IT capacity and resources
in older adults’ behavior related to searching for health-related
information online (8).
This study also confirmed two significant environmental
factors: social support and professional support. Our results
indicated that both factors showed positive impacts whereby the
effect of social support was stronger, demonstrating that support
from doctors, families, and friends can encourage older adults to
actively seek health information. This observation complements
the findings of previous studies that less communication with
professionals and families leads to online health information
seeking (21, 80). We empirically found that support from
professionals and families was significantly positively related to
older adults’ online health information seeking.
Our results also validate the direct effect and mediating role of
perceived benefit and health awareness for older adults. Specifically,
when such individuals believe that using IT is beneficial and
experience a high level of health awareness, they tend to seek health
information online. In particular, the perceived benefit of using
IT to seek health information revealed a much stronger impact
on older adults’ behavior than health awareness. Furthermore,
the effects of IT self-efficacy and IT innovativeness on online
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Ma et al. 10.3389/fpubh.2023.1147789

FIGURE 2
Structural model results. ***p < 0.001, **p < 0.01.

TABLE 4 Mediation effect test.

Mediator Path Indirect effect (95%) Direct effect (95%) Results

Size LLCI ULCI Size LLCI ULCI
PB ITS->PB->OHIS 0.186 0.1090 0.2625 0.463 0.3558 0.5592 Patrial mediating

ITI->PB->OHIS 0.215 0.1189 0.3069 0.399 0.2887 0.5090 Partial mediating

HA SS->HA->OHIS 0.067 0.0201 0.1144 0.315 0.2107 0.4195 Partial mediating

PS->HA->OHIS 0.038 0.0067 0.0481 0.474 0.4933 0.6564 Partial mediating

health information seeking were partially mediated by perceived
benefit, while the effects of social support and professional support
on online health information seeking were partially mediated by
health awareness.
6.2. Theoretical implications
This study contributes to the field by raising several theoretical
implications. First, this study enriches the research on online health
information seeking through investigating older adults’ online
health information seeking behavior. Although a few scholars
previously sought to understand older adults’ attitudes toward
searching for health information online (80, 81), they mainly
explored and summarized the factors influencing older adults’
behavior while neglecting to interpret how these factors motivated
their subjects to seek health information online. As far as we know,
our study is one of the first to address this issue. In particular,
due to older adults’ characteristics, their means of obtaining health
information is usually passive when compared to young people
(82). Therefore, clarifying the mechanism underlying older adults’
online health information seeking can shed light on how to
effectively facilitate this process for them while, at the same time,
deepening the scholarly understanding of this issue.
Second, this study empirically confirms the antecedents
of online health information seeking by contextualizing
older adults’ specific drivers. Drawing on social cognitive
theory, we integrally examined antecedents from personal
and environmental perspectives. Although factors such as IT
self-efficacy and social support have been identified as playing
significant roles in determining online health information
seeking (10, 66), this study takes a further step by empirically
verifying their effects on older adults’ behavior. Based on the
framework of social cognitive theory, we also authenticate
the significant role of IT innovativeness and professional
support. Furthermore, we clarify the differential impacts of
antecedents by comparing their effects, revealing the underlying
influence paths. Thus, this study not only comprehensively
highlights the impacts of different determinants but also
provides new understanding and suggests directions for
future research.
Third, this study contributes to social cognitive theory
by introducing it in the online health information seeking
context and validating the mediation role of perceived benefit

Frontiers in Public Health 08 frontiersin.org

Ma et al.
TABLE 5 Path coefficients comparison.
DV Path Path coefficient
OHIS βPB−>OHIS vs. βHA−>OHIS 0.589 ∗∗∗
vs. 0.177
PB βITS−>PB vs. βITI−>PB 0.285 ∗∗∗
vs. 0.508
HA βSS>HA vs. βPS−>HA 0.361 ∗∗∗
vs. 0.242
∗∗∗ p < 0.001.
and health awareness. Although social cognitive theory has
been widely applied in studies examining health behaviors
(83, 84), to our knowledge, no other scholars have previously
investigated online health information seeking from the
perspective of social cognitive theory. This study fills a gap
in the literature by providing a deeper understanding of
how older adults’ personal factors and environmental factors
comprehensively influence how they search for health information
online. Furthermore, this study certifies that older adults’
cognitions and perceptions (i.e., perceived benefit and health
awareness) significantly mediate the impacts of personal factors
and environmental factors on behavior. In this regard, this
study enriches the previous understanding of social cognitive
theory by revealing the influence mechanism of personal and
environmental factors.
6.3. Practical implications
The findings of this study lead to some practical suggestions
to aid the public, especially older adults, in actively seeking
health information online. For example, results illustrated
that both perceived benefit and health awareness significantly
enhance older adults’ search behavior, suggesting managers
and organizations should take corresponding measures to
improve older adults’ evaluation of information technology
and promote their health awareness. Accordingly, to enhance
perceived benefit, health information technology service
providers are encouraged to develop and optimize health
information seeking functions to improve user-friendliness,
such as increasing front size, simplifying search interface,
and adding guidance-related notes for older adults. These
tips will improve user-friendliness and are likely to increase
older adults’ perceived benefit and further promote online
health information seeking. In addition, since health awareness
is positively related to health information seeking behavior,
organizations and governments are encouraged to organize health
lectures and strengthen health publicity to improve older adults’
health awareness.
Moreover, IT self-efficacy has been found to play a significant
role in older adults’ perceived benefit and online health
information seeking, thus practitioners should address the
issue of improving older adults’ IT-related abilities. Along these
lines, health information technology companies are advised
to set up a special department for older adult users and send
staff to train such individuals on how to effectively use the
Internet to obtain health information. Furthermore, since IT
Frontiers in Public Health
10.3389/fpubh.2023.1147789
T value Conclusion
∗∗∗
116.384 ∗∗∗
βPB−>OHIS > βHA−>OHIS
∗∗∗
50.135 ∗∗∗
βITS−>PB < βITI−>PB
∗∗∗
4.755 ∗∗∗
βSS>HA > βPS−>HA
innovativeness significantly increases perceived benefit and
further promotes information seeking, we recommend that
information technology designers should develop exploratory
features for older adults to improve their innovativeness. For
example, developing exploratory games and displaying them
on login screens to encourage older adults act in a more
innovative way.
Lastly, results in this study demonstrated that social support
and professional support significantly enhance older adults’ health
awareness and further facilitate their efforts to find relevant
health information. Therefore, we strongly suggest that healthcare
workers and people surrounding older adults (e.g., family and
friends) should provide more support in terms of their health
management. According to our findings, a family doctor is
necessary for older adults, allowing them to obtain professional
information and medical support on a regular basis. Similarly,
since social support was shown to have a stronger positive impact
on older adults’ health awareness, we suggest that families and
friends offer more help and care to older adults, for example,
keeping an eye on their health and discussing health issues with
them regularly.
6.4. Limitations and future research
Although several notable theoretical and practical implications
emerged from the study findings, some limitations should
be addressed, which lead to suggestions for future research.
For example, this study used a cross-sectional survey to
examine the research model. Although tests were conducted
to verify that the results were not affected by common
method bias and multicollinearity, future research is strongly
recommended using mixed methods and a longitudinal design
to confirm the causal relationships. Furthermore, the research
was conducted on the Chinese mainland, potentially limiting
the generality of the research results. In particular, older
Chinese adults prefer collectivism in which social support is
more likely to play significant roles. Future research should
therefore take cross-cultural issues into account to reach more
interesting findings. Lastly, drawing on social cognitive theory,
we captured IT self-efficacy and IT innovativeness as personal
factors and incorporated professional support and social support
as environmental factors. However, technology characteristics,
such as the user-friendliness of information technology, may
also play significant roles and are worth investigating in
future research.
09 frontiersin.org
Ma et al.
Data availability statement
The original contributions presented in the study are included
in the article/supplementary material, further inquiries can be
directed to the corresponding author.
Ethics statement
The studies involving human participants were reviewed
and approved by Ethical Committee of the Harbin Institute of
Technology (N.2021-10 dated on 8th of November 2021). The
patients/participants provided their written informed consent to
participate in this study.
Author contributions
XM and PZ: conceptualization, methodology, and writing.
YL and RQ: methodology and writing. FM: review, editing, and
supervision. All authors contributed to the article and approved the
submitted version.
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Appendix

TABLE A1 Survey instruments.

Construct Questions Reference

Online health information seeking I frequently find health information online. (66)

I often use health websites.

I often seek health information on the internet.

Perceived benefit By using internet, I can seek health information in privacy conveniently. (47)

I can seek health information online whenever I want.

Seeking health information online can save me the time and effort.

Health awareness I reflect about my health a lot. (67)

I am very self-conscious about my health.

I am generally attentive to my inner feelings about my health.

IT self-efficacy I can complete the task such as seeking health information using internet if. . . (68)
(1) . . . there was no one around to tell me what to do

(2) . . . I had seen someone else using it before trying it myself.

(3) . . . someone showed me how to do it first.

IT innovativeness I am willing to try new information technologies. (69)

I think it is very interesting to try new information technologies.

I enjoy trying new information technologies.

Social support I can talk about my health problems with my family and friends. (70)

My family and friends are willing to help me in my health.

I get the help and support I need from my family and friends.

Professional support I can get the support I need from doctors and other health professionals. (71)

I can account on doctors to help and support me a lot with health problems.

I am satisfied with support from doctors and other health professionals.

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